An adventure in the NHS

Prescriptum . During my college years, one of my roommates was taking a hospital management course. Her tutor, a doctor, former minister, professor, and highly regarded figure in the healthcare field, taught her that "the biggest problem with the system is that those who decide on the system don't actually participate in it."

I'd been experiencing burning in my stomach and chest for a few months. During a routine ultrasound, they detected liver lesions of undetermined nature.

The doctor examining me asked when I would see my internist.

– “In a month.”

– “It can’t be, it has to be done in advance” and he wrote the report in which he prescribed the need for a more detailed evaluation through CT or MRI.

Of course, the pain immediately worsened, and a complicated paternal family health history of the stomach and pancreas did the rest.

The internist was on vacation, the outpatient clinic's coverage was exhausted, I called Saúde 24, waited 58 minutes. They answered, told me to call back and choose another option; they don't route calls internally. I called, they answered, and that wasn't the right option. "-but your colleague said yes," "-but no," I hung up, called back, and went back to the initial option. I explained the situation again, and they asked me if I was in my district. I don't even want to know what that means. I imagine Saúde 24 operates as if all districts were Lisbon, connected by trains, buses, boats, with Uber and taxis running 24/7. They scheduled an appointment for me at my health center that same afternoon.

The doctor on duty reviewed the report and prescribed two CT scans because health centers can't prescribe MRIs. For that, you have to go to a specialist appointment, which can take a year—I don't know, a long time. When you get the CT results, do as you did today: call Saúde 24 to schedule another appointment.

“- Again? Another hour of waiting”?

“- It’s here and the consultation is free”

“- Not for free. I pay taxes.”

I don't have a family doctor. Mine retired a few months ago, and there's been a replacement for as long as there's been one who no one wants to explain why she's not still working there.

I had a CT scan two days later and in the report the doctor concluded that I had cystic lesions in the pancreas, of considerable size, without obvious worrysome features using this imaging technique, recommending an evaluation by MRI.

New call to Saúde 24, I explain all this, they direct me to the hospital emergency room.

I enter the emergency room after noon, am triaged after one, show the CT scans, the nurse reads the report and tells me that "those who seek, find." He gives me a yellow wristband; I'm an urgent patient. They sit me in a room, with many older people around me, and it's heartbreaking, seeing the end like this. Anyway, I hear a lot of complaints, people who have been in this room since nine, googling how long I should be seen. I have a yellow wristband, one hour, almost there. Four doctors are scheduled for the emergency room, but none are there.

Four hours later a doctor appears and examines me right there in the room.

"I see you brought some tests. You should have gone to the Health Center. The doctor there hasn't uploaded the results yet." I reply that Saúde 24 sent me there. I open the CT scan report on my phone. She scrolls to the end, takes a photo, palpates, and asks questions that I don't have time to answer; she's not interested. The final question comes: "How long has it been since you had tests?"

“- For three weeks, a month…, I have them with me.”

“- It doesn’t matter, a year?, a month?, that’s what I want to know. Go get tested.”

She prescribed me Benuron and a sedative, but I didn't take the sedative. I had tests done, and an hour later, the nurse told me the doctor ordered two X-rays of the same areas where the CT scans had been done. I'm not a doctor, but it seems to me that a CT scan is a more comprehensive exam. I wonder why recent exams—CT scan results are a day old!—by credible entities with whom the NHS even works—can't be used, and I asked the nurse what the point was. She couldn't answer. Isn't this an incomprehensible waste of resources? I asked to speak to the doctor. The nurse looked for her in the offices where she wasn't and then left me at the door of another room, where the doctor was, and told me to ask my colleagues to call her. They sent me back to my office, where the doctor had told me to wait. I pace back and forth for an hour, then an assistant comes to call me because two transports had been requested for me to the X-ray (a transport is the walk accompanied by the assistant from the waiting room to the exam room). There are few people this time, and 45 minutes later, I still haven't been called. A nurse comes up to me and asks if I'm waiting for any tests. I tell her what's going on, and checks the system; no tests are requested in my name. I return to the emergency room. The nurse confirms in the system that the doctor requested the transports, but not yet the tests. I ask to speak to the doctor again and say I want to leave. The nurse replies that it's best to speak to the doctor so that the record doesn't show that I left the emergency room.

“- Abandonment, what abandonment? I'm not abandoning, the doctor abandoned me.”

The nurse takes me to the door of the room where the doctor is and tells me to ask my colleagues to let her know that I want to speak to her.

“- Tell him you’re leaving, it might have an effect.”

Apparently it does because the doctor tells me to wait at the door.

I look at the scene: a huge table in the middle of the room, perhaps ten doctors and possibly nurses on each side typing on computers. How much bureaucracy will the doctors have to deal with, and how much time does this take away from the effective delivery of healthcare?

An hour later the doctor comes to see me, hands me an envelope, and discharges me.

I tell her she forgot to request the X-rays in the system, and she replies that she had the CT scans and that it wasn't worth it. I look at her in astonishment; she already knew that six hours ago!

“- And the CT scan conclusions?”

“I don’t see anything there, but that’s not my specialty.” I’m in disbelief, six hours later he tells me he’s not a specialist in my illness.

“ – Then why don’t you refer me to a specialist?”

He doesn't answer and hands me a sealed envelope. He tells me to call Saúde 24 to go back to my Health Center and show the doctor the CT scan results. He adds that if I continue to have pain and go, for example, on vacation to Tavira, I can go to the Health Center, give the letter to the doctor on duty, and I'll be seen (sic). WTF?

Once home, I open the envelope and read the "Clinical Diary." It says I denied all the symptoms he asked me about, using technical terms I don't understand, but there are three he lies about: nausea, dizziness, and burning sensation. Unless the "currently" that precedes the statement of my denial has to do with the exact moment he examined me, because I wasn't actually nauseous for those precise five minutes.

A doctor friend explained to me that perhaps the doctor at the health center was actually keeping me in the system because, if he wanted to get rid of me, he would refer me to the specialist and I would disappear from the radar until I had an appointment, perhaps a year.

I go to CUF, meet my internist at the bar, tell him what's going on, he looks at the report, calls me and tells me that I have lesions, which could be benign, but could also be malignant, that the best thing would be to do an abdominal-pelvic MRI to rule it out and see what I do from there.

“ – How worried should I be?”

“ – Moderately”.

I schedule the MRIs. For a month now, Tony Soprano, lying in the MRI machine, asking his wife, "Do I have cancer?", has been on my mind.

– “We’ll find out soon,” she replies.

The morning I delivered this article, I learned, thanks to God—and the means he gave me—that I don't have it.

I also know that, for the NHS, tests performed outside the NHS are not valid, nor are CT scans valid. Are MRIs valid? If they detect something wrong, it doesn't matter; in the NHS, it's back to square one? A patient pays out of pocket, takes the results to the NHS, and the NHS orders a repeat, not because it has doubts, but because it does. The taxpayer, who may even be the same patient, pays again.

I also know that, not being chronically ill, pregnant, or under 12 years old, I'm not a priority for the NHS. I understand that, since resources are scarce, we have to establish priorities. What I don't understand is how this isn't reflected in the taxes we pay. The amount of healthcare deductions is a joke, considering healthcare costs.

Furthermore, even if someone had all the money in the world, they wouldn't be able to buy private services that only the NHS can provide. But the NHS is like a company in which we are shareholders, but to which we have no access.

Postscript

Health insurance is increasingly expensive to provide decent coverage, and they make unreasonable demands. The insurer recently asked me for ATM receipts that are no longer used, the invoices no longer arrive, and messages keep coming back saying that the supporting documents for expenses are illegible.

Private healthcare groups have fewer and fewer agreements with insurance companies, not to mention the NHS: doctors, exams, procedures—everything and everyone—have fewer and fewer agreements with insurance companies. So many Portuguese have health insurance because the NHS doesn't respond to our needs in a timely manner that even private providers no longer have the capacity. Doctors say insurance companies pay less and less, even though they charge more and more. Their workload isn't worth it. Nurses' phone calls in the days beforehand to prepare medical procedures have stopped, telephone assistants don't answer questions, and billing is often incorrect.

Waiting times in the NHS are unbearable, most of the time not because they're a matter of life or death, but because they condemn people to a poor quality of life while they're not being treated. And that's like dying a little, isn't it?

With so much installed capacity, why isn't it integrated? Why are we paying so many different agents, yet their responses are increasingly inadequate?

Preventative medicine saves lives, but unless we're chronically ill, we're rarely called in for a routine checkup. Do we have to be dying to be treated?

What are we paying for after all?